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l Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number y 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A © 9 8 2 0 3 0 2 0 7 1 8WJ37-7-7267 0188U198 JJK 5. a ator' am n ai Add ess pVtPAREYiQDIt F -Ifwgoindfit neralors Sito Address(if different than mailing address) �n�n sl c c 'a Pt�oacs nloi�Pacific IgAroad 1400 t7ai.tcl &Street-ftp 1030 833 E 81h Street Omaha NE 68179 SWkton CA 95206 Generator's Phone: 9 1 6 640 - 0 4 9 6 6.Transporter Arneriaan fntegrate+d Services, Inc. U.S.Name EA lR U0 0 0 1 4 8 3 3 8 7.Transporter 2 Company Name _ U.S.EPA ID Number lL- _ (Ek\yt✓bv1w 1VV U l UW �. 8. si na ed `fir ShF ci' Na a and fie Address U.S.EPA ID Number Y +rar on,t�tic. 1630 W.17th Street Lang Beach CA 9113 j Facility's Phone: = 432'646 IC A D 0 2 8 4 0 9 0 1 ga, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity .Wt.Nol. 13.Waste Codes I Norl E tmili Wast,Liquid(Hydra 00) 221 0 01 DF 5,15 G w 214on-RCRA K rdo Ms*,Liquid(Cats L.ub tart 331 i QF 1 © I i 4. i DAB —..�...-- �� [.11YII I 14. p�l Itlinlgn►stdu(ions > go I�ngrmaE3on Wt9F1 handlingWc�:1t:H. wC�] �9 volumes a1�6 d s��: r� approximate. 9b.1 Prefile1 \\� 91 .3) Prerfile # � j 9b.2 Profile #V1211r Project #79023--44 WR#21894 1-14413 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable interna' and national governmental re )tions. if export shipment and I am the PrimaryExporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgmentof onse it.I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) ifI a mall quantity g erator)s e. Generator's/Offeror's Printedffy ed Name Signat Month Day Year AIS On Behalto�GenemtorJ.Holughtailing � i —.r 16.International Shipments z ❑Import to U.S. ❑Export from U.S. 1 of entry/exit: Transporter signature(for exports only): t}al leavin U.S.: W 17.Transporter Acknowledgment of Receipt of Materials OTransporterL Printed/Typed Name J Signature Month Day Year TFT-der oder 2 Prinledffyped Name Signature Month Day Year I t Sc�,S' 16110 iL5 18.Discrepancy 18a•Discrepancy Indication Space ❑ QuantityT e ❑ yp El Residue ❑Partial Refection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number � I U { rte+ Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdntedrTpedName AlrSignature ✓ Month Day Year A7 Z12 2 EPA Fo 8 0 -2 ev.3-05) re sous editions ar obsolete. pE6Bf.,IVATEt`F AQId_ITY TO DESTINATION STATE(IF REQUIRED)